1. Field of the Invention
The subject invention is directed to a minimally invasive surgical procedure, and more particularly, to an endoscopic surgical procedure for treating gastroesophageal reflux disease, and apparatus for performing the procedure.
2. Background of the Related Art
Gastroesophageal reflux disease (GERD) is one of the most common upper-gastrointestinal disorders in the western world, with a prevalence of approximately 360 cases per 100,000 population per year. Approximately 25 will eventually have recurrent, progressive disease and are candidates to undergo anti-reflux surgical procedures for effective long term therapy.
GERD is a condition in which acids surge upward from the stomach into the esophagus. Backflow of acid into the esophagus makes it raw, red and inflamed, producing the condition known as esophagitis; it also causes the painful, burning sensation behind the breastbone known as heartburn. Backflow or reflux of acid can occur when the sphincter or band muscle at the lower end of the esophagus fails to stay closed. This sphincter is called the lower esophageal sphincter (LES). The LES acts as a valve to the stomach, remaining closed until the action of swallowing forces the valve open to allow food to pass from the esophagus to the stomach. Normally the valve closes immediately after swallowing to prevent stomach contents from surging upward. When the LES fails to provide that closure, stomach acids reflux back into the esophagus, causing heartburn.
The general approach for corrective surgery involves creating a new valve or tightening the existing valve. This procedure is known as “fundoplication” and is used to prevent the back flow of stomach acids into the esophagus. Various fundoplication procedures have been developed to correct GERD and are known as Nissen fundoplication, Belsey Mark IV repair, Hill repair and Dor repair. Each surgical procedure has its own unique attributes; however, each requires an invasive surgical procedure, whereby the individual must endure trauma to the thoracic cavity. The individual remains hospitalized after the procedure for about six to ten days.
The Nissen fundoplication technique involves enveloping the lower esophagus with the gastric fundus by suturing the anterior and posterior fundal folds about the esophagus. Modifications of this procedure include narrowing of the esophageal hiatus posterior to the esophagus, anchoring of the fundoplication to the preaortic fascia and surgical division of the vegus nerve. The degree of the fundal wrap can be modified to incompletely encircle the esophageal tube to avoid gas float syndrome and has also been modified to include a loose wrap. Similarly, the Belsey Mark IV repair, Hill repair and Dor repair are directed to modifications for encirclement of the esophageal tube by fascia.
Complications of these fundoplication procedures include the inability to belch or vomit, dysphagia, gastric ulcer, impaired gastric emptying and slippage of the repair that may foil the best surgical results. Therefore, the fundoplication procedures have been modified to adjust the length and tension of the wrap, include or exclude esophageal muscle in the sutures and leaving the vagus nerves in or out of the encirclement.
A relatively new fundoplication technique is known as Nissen fundoplication laparoscopy. In contrast to the traditional Nissen fundoplication procedure, which requires a 6 to 10 inch incision and a 6 to 10 day hospital stay with up to 8 weeks of recovery at home, the laparoscopy technique is performed through small openings about the abdominal cavity and most patients tend to leave the hospital in two days and can return to work and other activities within a week or two. Despite the benefits of less invasive laparoscopic fundoplication procedures, there is still a need for a minimally invasive corrective treatment for GERD that can be performed on an out-patient basis.